Gut transplantation is at a stage comparable to that of transplantation of the heart and liver in the late 1960s. The feasibility of this procedure has been demonstrated in large animals but has not been successful in clinical practice. Rejection, sepsis, and possible GVHD are the major obstacles. Ongoing clinical trials can be justified on the basis of the limited options that are available for patients with the short gut syndrome who develop complications while on TPN, the improved results in animals studies, the recent clinical success of pancreaticoduodenal transplantation, and the demonstrated ability to detect rejection and remove the intestinal graft without mortality (Table 1).